灌注液溫度對輸尿管鏡手術(shù)效果的影響

向俊　劉湘鄂　林晨　何穎　李晨

[關(guān)鍵詞] 輸尿管鏡;鈥激光碎石術(shù);輸尿管結(jié)石;灌注液;溫度

[中圖分類號] R699? ? ? ? ? [文獻(xiàn)標(biāo)識碼] A? ? ? ? ? [文章編號] 1673-9701（2021）22-0004-04

The influence of perfusate temperature on the effect of ureteroscopy

XIANG Jun? ?LIU Xiang′e? ?LIN Chen? ?HE Ying? ?LI Chen

Department of Urology， the Third People′s Hospital of Jingzhou City in Hubei Province， Jingzhou? ?434001， China

[Abstract] Objective To evaluate the effect of perfusate at different temperatures on the effect of ureteroscopic holmium laser lithotripsy. Methods A total of 144 patients with ureteral calculi needing ureteroscopic holmium laser lithotripsy who were admitted to our hospital from March 2018 to November 2020 were selected as the research objects， and randomly divided into the normal temperature isotonic saline perfusion group（n=75） and 38℃ isotonic saline perfusion group（n=69）. The operation time， body temperature changes， stone uplift rate， surgical complications， stone removal rate， secondary surgery or extracorporeal lithotripsy rate of the two groups of patients were recorded and compared. Results The operation time was （35.70±9.11） minutes in the 38℃ isotonic saline perfusion group， which was shorter than that of （42.88±8.75） minutes in the normal temperature isotonic saline group， and the difference was statistically significant （P<0.05）. The body temperature change， stone uplift rate， stone removal rate， surgical complications rate， secondary surgery or extracorporeal lithotripsy rate in the 38℃ isotonic saline perfusion group were significantly lower than those in the normal temperature isotonic saline group， and the difference was statistically significant（P<0.05）. Conclusion Compared with normal temperature isotonic saline， the use of 38℃ isotonic saline perfusion during ureteroscopy can significantly improve the laxity of the ureter，reduce the incidence of surgical complications， prevent the stone from moving up， and does not increase the patient′s hospitalization costs. It is worthy of clinical promotion.

[Key words] Ureteroscopy; Holmium laser lithotripsy; Ureteral calculi; Perfusate; Temperature

輸尿管結(jié)石是一種泌尿外科常見病，可導(dǎo)致疼痛、血尿、感染等多種癥狀，當(dāng)藥物治療或體外震波碎石無效時，常需采用輸尿管鏡鈥激光碎石術(shù)處理[1]。在輸尿管鏡鈥激光碎石術(shù)中，需要使用等滲鹽水灌注液進(jìn)行沖洗，以保證清晰的視野和手術(shù)的正常進(jìn)行。灌注液的不正確使用，會導(dǎo)致結(jié)石上移、腎周積液、泌尿系感染加重等后果;術(shù)中大量的低體溫灌注液反復(fù)沖洗術(shù)野，會帶走大量的熱量，導(dǎo)致患者體溫的改變，造成多器官的功能受限，嚴(yán)重時會導(dǎo)致尿源性膿毒血癥[2]。近幾年行輸尿管鏡鈥激光碎石術(shù)時發(fā)現(xiàn)，在使用常溫等滲鹽水灌注液進(jìn)行灌注時，輸尿管痙攣的發(fā)生率較高，而將灌注液加熱后，輸尿管痙攣的發(fā)生率下降。本研究采用前瞻性研究評估常溫等滲鹽水灌注液和38℃等滲鹽水灌注液對輸尿管鏡鈥激光碎石術(shù)手術(shù)效果的影響，現(xiàn)報道如下。